With a 10-day supply of opioids, 1 in 5 become long-term users

Nope. I'm pointing out that replacing one potentially addictive drug with another has **never worked** although it has been attempted dozens of times. Yes, Pregabalin is probably less addictive than oxycodone, but the DEA schedules in general don't have much to do with reality or research. Recall that marijuana is a Schedule I drug (high addiction potential, no medical use) and Marinol - concentrated THC - is a Schedule III drug.

Addiction / chronic use (those terms ARE NOT equivalent) and the regulatory structure surrounding prescribed drugs is a morass of opinion, fear, controlling behavior and general human dysfunction.

Several years ago I was at a gun range when the rifle I was using exploded in my hand. Nothing too serious, I took several pieces of metal fragments to my hand and burned my hand and arm. While I was in the ER they gave me some Vicodin, which was when I discovered I have a sulfa allergy. The Vicodin hurt more than the injury did, so now I rarely ever take pain meds if I ever need them, and if I do the strongest tends to be ibuprofen.

I could never take cannabinoids personally. They easily cause me panic attacks (I intensely dislike the mental numbness they cause, the distortion of time, the memory issues, the nausea, and every time I've tried cannabis I've had to go outside for some fresh air).

I was having a hard time describing people returning and getting the refills without using terminology that's extremely charged and degrading. These are generally people who need help, not people who should be lumped into some generic "not a good enough person" category. Our current culture doesn't really have a lot of easy ways to say that sort of thing.

Don't confuse "addict" with "not a good enough person." These are powerful drugs and unintended addiction is common. Few people start off with the intention of abusing these drugs but they wind up abusing anyway and this is a huge and increasing problem in America at least.

We've known for a while. However, when you tie compensation to patient satisfaction scores, guess what happens. Luckily I work for a department that acknowledged the risks early and created formalized guidelines for narcotic prescriptions. Even having written policy handouts still doesn't prevent me from having to call security at least once a shift to escort out agitated patients who believe they are owed narcotics.

(edit: grammar)

What part of the Hippocratic Oath compels you to hook them on opiods and then turn away from helping them and instead unleashing some enforcement action upon this ongoing march of needful patients and unwell spirits poisoned and addicted by your medical practice? That to me sounds like anti-medicine.

Health insurance policies trump the Hippocratic Oath any day of the week. For profit!

Yeah, but unlike marijuana, opioids come from some pretty huge pharma co's that are paying good money.. I mean lobbying so their profits stay untouchable.I can't wait for the days when our govt mandates everyone take their daily pill that keeps us obedient and "happy", or suffer punishment./s

I am not joking when I say that if I had access to an unlimited supply of opiates, I'd take them every day. Absolutely, 100%. Because they're fucking awesome.

And that terrifies me.

This. I managed to break a couple of ribs and my elbow (type 2 radial head fracture) and got prescribed Tramadol. It was awesome - and apparently that's the 'safe' stuff.

For that reason I only took them for one day and then decided to bear the pain and use regular painkillers (ibuprofen/paracetamol.) I know my personality, and I know something I could get far too fond of far too easily when I see/feel/take it it...

I could never take cannabinoids personally. They easily cause me panic attacks (I intensely dislike the mental numbness they cause, the distortion of time, the memory issues, the nausea, and every time I've tried cannabis I've had to go outside for some fresh air).

They make strains that have very little THC and a high amount of CBD which don't do that.

You'd just need to find the right strain for you. Some folks get over the panic attacks as well after a few uses. But it is a side effect in some people however they do make strains to accomidate that. There are different cannabinoids that change the way you react to the THC, it's all synergistic which is why we need to open the doors to studies.

I can go to the dispensary and get 99.9% CBD crystals. I mix them with high THC concentrates to get the added benefits of CBD. CBD isn't psychoactive, you could consume the 99.9 CBD if you wish to avoid the high altogether. CBD has anti-inflammatory and pain killing properties. THC helps the patient ignore the pain and get it out of their mind, thus increasing their pain tolerance. Opioids have been shown to decrease your pain tolerance leading to a feedback loop of bigger doses, it's not just the drug tolerance chronic users deal with. This is why opioids are not so good for chronic pain.

I was having a hard time describing people returning and getting the refills without using terminology that's extremely charged and degrading. These are generally people who need help, not people who should be lumped into some generic "not a good enough person" category. Our current culture doesn't really have a lot of easy ways to say that sort of thing.

Or, people in severe need of pain relief has the same need over a long time?

The new CDC recommendations mentioned in the article (to extremely over simplify) are to not prescribe opioids for chronic pain except in cases of cancer, palliative care, or end of life care. People in severe need of pain relief over a long period of time should not be utilizing this type of medication.

The problem being that the 'other treatments' that the CDC likes to push are just as poorly studied as opiates. While they have some efficacy, to say that they can simply replace opiates on a broad scale is more than a little disingenuous.

For example, Pregabalin (Lyrica) was one of the touted medications to get people off of opiates. Except that the DEA has placed it on the controlled substances list. Oops.

Are you trying to imply that people aren't able to get a drug to help them get off a Schedule II controlled substance (the most heavily regulated group that can still be purchased) because the the replacement drug is a Schedule V (the least regulated group)?

Nope. I'm pointing out that replacing one potentially addictive drug with another has **never worked** although it has been attempted dozens of times. Yes, Pregabalin is probably less addictive than oxycodone, but the DEA schedules in general don't have much to do with reality or research. Recall that marijuana is a Schedule I drug (high addiction potential, no medical use) and Marinol - concentrated THC - is a Schedule III drug.

Addiction / chronic use (those terms ARE NOT equivalent) and the regulatory structure surrounding prescribed drugs is a morass of opinion, fear, controlling behavior and general human dysfunction.

So using methadone to wean heroin addicts off the physical dependency has never worked? Literally no person ever underwent a successful Suboxone regimen? Zubsolv has literally no purpose except to distract from the One True Cure - marijuana?

I get that you're passionate about having that particular Schedule I reclassified, but try rein it in a little bit here.

As noted in the article, the study found that initial 30 day prescriptions for these drugs made up a very small portion of total scripts. What appears to be implied or stated by the study is that people who received a 10 day script often came back for more, and managed to get doctors to keep writing new scripts for extended periods of time.

When I broke my shoulder a couple of years ago, the ortho I saw for treatment had no problem refilling my scrip of 30x 5/325 Norcos (aka, vicodin) three times. As opiates go these are the entry-level ones; taking two per day, I stretched each bottle for about two weeks (it doesn't take much to bring on the high for me, and even after six weeks, two pills was still enough). Nothing illegal or shady about it, since I was still in legit pain for most of that time and it was legit treatment, but honestly I felt like I'd won the lottery.

And that was when I realized that I was standing on a very real cliff, because part of me—a very dark, very quiet, but very scary part—would whisper to me from time to time: "You know, breaking a bone or two in order to get more pills after you're done with this injury doesn't sound so awful, does it?"

It was a stark, viscerally terrifying reminder that "addicts" aren't limited to homeless guys shooting crack under an overpass—drugs make you feel awesome and chasing that feeling can fuck up your life, hard.

When I hear people talk (or in this case, write) like this, I cannot help but think of Larry Niven's "Wireheads" and wonder when, in this age of biotechnology, these types of implants will be available.

I just one thing and I'll move on. As someone who knows and has experienced non-drug related connectedness to the universe and though that the types of feelings which you have experienced though drug use, I can say that there is another way.

I am not joking when I say that if I had access to an unlimited supply of opiates, I'd take them every day. Absolutely, 100%. Because they're fucking awesome.

And that terrifies me.

This. I managed to break a couple of ribs and my elbow (type 2 radial head fracture) and got prescribed Tramadol. It was awesome - and apparently that's the 'safe' stuff.

For that reason I only took them for one day and then decided to bear the pain and use regular painkillers (ibuprofen/paracetamol.) I know my personality, and I know something I could get far too fond of far too easily when I see/feel/take it it...

I know people who like tramadol, for me it's one of the worse highs I've ever felt, it makes me feel clammy and ill and like I'm in an interrogation room. I had it once with a broken toe, I had to take it because I couldn't walk otherwise.

Just use cannibanoids. They're safer, work far, FAR better than any opioid man ever created, and are in no way addictive.

Plus, they are natural. And the best part, you can grow the shit in your backyard in 27 states. No need to pay a drug pusher like Roche.

While for minor to moderate pain that may work (and I have very much rejected opiates from the doctor in favor of that specific herbal remedy for pain on some occasions), it is situation specific.

Opiates can do something about pain which goes well beyond what you can tolerate on anything else. That is the entire problem, they are physically addictive, dependence forming in many people, and have no good replacement in many cases.

We've known for a while. However, when you tie compensation to patient satisfaction scores, guess what happens. Luckily I work for a department that acknowledged the risks early and created formalized guidelines for narcotic prescriptions. Even having written policy handouts still doesn't prevent me from having to call security at least once a shift to escort out agitated patients who believe they are owed narcotics.

(edit: grammar)

What part of the Hippocratic Oath compels you to hook them on opiods and then turn away from helping them and instead unleashing some enforcement action upon this ongoing march of needful patients and unwell spirits poisoned and addicted by your medical practice? That to me sounds like anti-medicine.

Health insurance policies trump the Hippocratic Oath any day of the week. For profit!

I don't know if you know this, but oxycodone isn't free. The last thing a health insurance policy wants to do is pay for opioids that could have been avoided. That's why they've added all those prior authorization requirements before allowing fills (except where employers have paid extra to opt out of them). There's this bizarre belief by so many people that health insurance companies want their members to constantly be using any and all drugs available for sale on the market today. Every time their members pick up a drug it costs them money. The absolute last group you should be blaming for doctors pushing pills is the insurance companies.

I know people who like tramadol, for me it's one of the worse highs I've ever felt, it makes me feel clammy and ill and like I'm in an interrogation room. I had it once with a broken toe, I had to take it because I couldn't walk otherwise.

It sounds like you might have been better off believing your toe when it told you not to walk on it.

I am not joking when I say that if I had access to an unlimited supply of opiates, I'd take them every day. Absolutely, 100%. Because they're fucking awesome.

And that terrifies me.

This. I managed to break a couple of ribs and my elbow (type 2 radial head fracture) and got prescribed Tramadol. It was awesome - and apparently that's the 'safe' stuff.

For that reason I only took them for one day and then decided to bear the pain and use regular painkillers (ibuprofen/paracetamol.) I know my personality, and I know something I could get far too fond of far too easily when I see/feel/take it it...

If you managed to get really high off tramadol in a single day then I would almost guarantee that you are likely a ultrarapid metabolizer associated with the CYP2D6 gene.

I know people who like tramadol, for me it's one of the worse highs I've ever felt, it makes me feel clammy and ill and like I'm in an interrogation room. I had it once with a broken toe, I had to take it because I couldn't walk otherwise.

It sounds like you might have been better off believing your toe when it told you not to walk on it.

If I could have afforded the time off of work I'd have done so. Unfortunately wrapping the toe, a sturdy shoe, and pills that made me feel like crap allowed me to keep the money coming in.

Interesting thing about Tramadol is that it also has the added bonus of addicting you like an antidepressive would so you get a double withdrawal from it.

We've known for a while. However, when you tie compensation to patient satisfaction scores, guess what happens. Luckily I work for a department that acknowledged the risks early and created formalized guidelines for narcotic prescriptions. Even having written policy handouts still doesn't prevent me from having to call security at least once a shift to escort out agitated patients who believe they are owed narcotics.

(edit: grammar)

What part of the Hippocratic Oath compels you to hook them on opiods and then turn away from helping them and instead unleashing some enforcement action upon this ongoing march of needful patients and unwell spirits poisoned and addicted by your medical practice? That to me sounds like anti-medicine.

Perhaps you are confusing me with the providers who wrote the addicting prescriptions in the first place. My standard practice is, and always has been, very limited doses for acute illness only. Regarding calling security, I and my staff have better things to do than wait around patiently while someone screams, "BUT I KNOW MY BODY!" and "MY DOCTOR ALWAYS GIVE ME DILAUDID!" after I give them a written copy of the departmental pain policy and tell them that I do not administer or prescribe opioids for chronic complaints.

@porkface: Thank you for that! I've had my fair share of Hydrocodone, and I was completely puzzled as to the statistics in the article concerning addiction. From my point of view, the most attractive property of painkillers is that they kill pain -- and that's not nothing -- but I had no idea what kind of "addictive" properties were calling out to people. If I reacted like you do, I bet I'd be addicted, too.

I don't think the current opioid problem will start to find any resolution until people with the writing skills and editorial influence such as yourself really manage to get people to realize that this addiction can and does happen to anybody. The idea of the drug addict being weak or choosing to use the drugs does nothing good for society when a week on painkillers can destroy a life.

I mean...they're pills that you can take and they make you feel awesome. Not "WOOOOO I CAN FLYYYYYY GONNA JUMP OFF A BUILDING!!!!" PCP awesome, or "WOOO I CAN KILL A COP WITH MY BARE HANDS!!!!!" bath salts awesome, or anything else violent or crazy or whatever. Just quietly, intensely, calmly, reassuringly awesome. They can make a boring afternoon exciting because of how good you feel; they can make a hopeless situation hopeful because of how good you feel.

If you're a near-broke unemployed person in rural West Virginia and you have a choice between going out and trying to scrounge for work or popping an Oxy and sitting in your crappy trailer feeling like it's a palace and watching reruns of the most interesting and amazing Wheel of Fortune episodes you've ever seen, what are you going to pick? Opioids make bad real life situations into good, wonderful situations—more, they make you feel like everything is gonna be okay. Even if it clearly isn't, they make you feel like it is.

"Weak people get addicted to drugs" is a tired, broken narrative. The reality is that, kinda like I said, people get addicted to drugs because most drugs make you feel pretty fuckin' great. Opioids make me feel awesome, even if shitty things are happening. Seen from that perspective, it's pretty obvious why people are using the crap out of them.

I don't think it's necessarily "weak" to seek escape from a shitty life by taking a pill that's pretty much guaranteed to temporarily make you feel like everything in your life is good. It's human. It's a lot less useful than actually trying to improve your life, but it's also a lot easier.

I'll be honest, that's the part I really don't understand, despite taking opioids and other prescription drugs that are all said to have that sort of effect - they just don't have that effect upon me.

Maybe I should sue my doctor?

I suppose I should just be grateful that they (more or less) manage to dull the pain...

Different substances work differently on different people. I'm fortunate in that I don't seem to have the predisposition for addiction either. But I can certainly understand the lure of taking a pill that makes you feel good and forget about your problems for a little while. Despite being very introverted, my most rewarding moments have been when helping others, interacting with other people. Maybe this is the kind of feeling good that should be emphasized more, rather than competitiveness.

I have chronic pain. I have had morphine ("enough to put down a horse") once and dilaudid a few times, and have a script for 7.5/325 Norco. Not once in 20 years have I ever had euphoria, but I also have never had an opiate when I am not in pain, so maybe I would get the euphoria if not in pain. The withdraw symptoms suck, headache and tremors which make it difficult to sleep and can in turn lead to more pain. The side effects of long term use are also bad and have limited my lifestyle at times IBS). I have never had an issue stopping the opiates, the headaches from withdrawal (3/10) are not bad as migraines(6-9/10) or kidney stones(3-8/10, but until the DEA and police gets out of the graft business, there will be no viable, legal alternative.

I want an alternative and I have tried every class of prophylactic and abortive medicine and therapy there is aside from surgical. Most do not work for more than a year with the exception being Botox which does not prevent pain all the time.

The one period in the last 20 years when I did not have a single migraine for two years was when I used marijuana in college.

Yeah, but unlike marijuana, opioids come from some pretty huge pharma co's that are paying good money.. I mean lobbying so their profits stay untouchable.I can't wait for the days when our govt mandates everyone take their daily pill that keeps us obedient and "happy", or suffer punishment./s

..just as "Equilibrium" has foretold!

It's not they lobbying you need to worry about. It's the convincing doctors that they should be prescribing narcotics in the first place. You actually need to register to prescribe them and somehow the pharma's got doctors to do both of these things.

I have chronic pain. I have had morphine ("enough to put down a horse") once and dilaudid a few times, and have a script for 7.5/325 Norco. Not once in 20 years have I ever had euphoria, but I also have never had an opiate when I am not in pain, so maybe I would get the euphoria if not in pain. The withdraw symptoms suck, headache and tremors which make it difficult to sleep and can in turn lead to more pain. The side effects of long term use are also bad and have limited my lifestyle at times IBS). I have never had an issue stopping the opiates, the headaches from withdrawal (3/10) are not bad as migraines(6-9/10) or kidney stones(3-8/10, but until the DEA and police gets out of the graft business, there will be no viable, legal alternative.

I want an alternative and I have tried every class of prophylactic and abortive medicine and therapy there is aside from surgical. Most do not work for more than a year with the exception being Botox which does not prevent pain all the time.

The one period in the last 20 years when I did not have a single migraine for two years was when I used marijuana in college.

I never took a pill when I wasn't in pain either, the problem for me was that I was always in pain, 24-7. It never left. It's still there after the pills but it went from being 6-8 on the pills to being a 1-4 (on the subjective scale) off the pills.

We've known for a while. However, when you tie compensation to patient satisfaction scores, guess what happens. Luckily I work for a department that acknowledged the risks early and created formalized guidelines for narcotic prescriptions. Even having written policy handouts still doesn't prevent me from having to call security at least once a shift to escort out agitated patients who believe they are owed narcotics.

(edit: grammar)

What part of the Hippocratic Oath compels you to hook them on opiods and then turn away from helping them and instead unleashing some enforcement action upon this ongoing march of needful patients and unwell spirits poisoned and addicted by your medical practice? That to me sounds like anti-medicine.

Perhaps you are confusing me with the providers who wrote the addicting prescriptions in the first place. My standard practice is, and always has been, very limited doses for acute illness only. Regarding calling security, I and my staff have better things to do than wait around patiently while someone screams, "BUT I KNOW MY BODY!" and "MY DOCTOR ALWAYS GIVE ME DILAUDID!" after I give them a written copy of the departmental pain policy and tell them that I do not administer or prescribe opioids for chronic complaints.

What is your view on marijuana for pain management?

For many things it seems like it has some real benefits over opiates, even if it cannot entirely replace them. Would you prescribe it if you could, and what kind of response would you give a patient who asked about doing that on their own instead?

I am not joking when I say that if I had access to an unlimited supply of opiates, I'd take them every day. Absolutely, 100%. Because they're fucking awesome.

And that terrifies me.

This. I managed to break a couple of ribs and my elbow (type 2 radial head fracture) and got prescribed Tramadol. It was awesome - and apparently that's the 'safe' stuff.

For that reason I only took them for one day and then decided to bear the pain and use regular painkillers (ibuprofen/paracetamol.) I know my personality, and I know something I could get far too fond of far too easily when I see/feel/take it it...

If you managed to get really high off tramadol in a single day then I would almost guarantee that you are likely a ultrarapid metabolizer associated with the CYP2D6 gene.

Very interesting, thank you. If that's heritable, it seems remarkably plausible given my family history (my mother has long term serious mental health issues and finding antidepressants that would even touch it has been a decades-long saga - a little light googling suggests CYP2D6 UM is linked...: http://www.mdedge.com/currentpsychiatry ... hey-linked)

All speculation and one anecdote is not data of course. But very interesting, nevertheless - thanks again!

I get really skeptical of what to take from these kinds of studies. Okay, opiates are very addictive for some people, that is a fact. Otherwise, we're talking correlation.

Looking at the link, I'm skeptical that the authors really know that the percentage of patients in question that had no long term problem with addiction. Okay, their history doesn't show it, but how many of them drink or otherwise had access to opiates or other addiction problems? Addicts lie. People who get opiates are partially self-selecting, too, because addicts (or potential opiate addicts) are going to be more likely to get themselves prescribed opiates. On the other hand, there were a lot of people's data consulted, so maybe that evened things out some.

Plus, it's hard to say in broad generalizations whether the prescriptions for pain were incorrect. Chronic pain is life-crippling. It's easy to speak out against opiate prescriptions when you aren't the one suffering.

I am a lucky person for whom opiates work to kill pain, but otherwise make me feel awful until they wear off. My experience was with short-term use following surgery. I have had temporary back pain though, and it was really enlightening with regards to what people with permanent problems have to deal with. Be careful making pain generalizations if you are in your 20s.

I think that there is a genetic component involved in the addiction. I am a cancer patient and had been on OxyContin and oxycodone for +4 years. Once I realized that the opioids were making me an aggressive asshole, I went a reduction schedule and stopping completely within 60 days. I had zero withdrawal symptoms. Now I manage with over the counter pain drugs.

I'm pretty certain that's the case. I was prescribed oxycontin for about 3 weeks as I recovered from ankle surgery. That's on top of having them prescribed for a week while waiting for surgery. At some point, I figured out the pain reduction was close to nil, and the drugs were just making me loopy. So I stopped. No side effect whatsoever.

Then there's my sister-in-law, who got hooked on them rather quickly.

The odd part is that I have an addictive personality, and need to watch my patterns. But thankfully, that doesn't seem to extend to opioids.

Considering that alcoholism is know to have a genetic component, I'm surprised as well that this hasn't been studied more.

@porkface: Thank you for that! I've had my fair share of Hydrocodone, and I was completely puzzled as to the statistics in the article concerning addiction. From my point of view, the most attractive property of painkillers is that they kill pain -- and that's not nothing -- but I had no idea what kind of "addictive" properties were calling out to people. If I reacted like you do, I bet I'd be addicted, too.

There's a variety of reactions. I had hydrocodone once. My experience of it was it was unpleasant. I felt disconnected and not at all myself. Then in the middle of the night I passed out while trying to stand up after taking a piss and got a nice concussion out of the deal. I stopped taking it immediately because I'd rather have the pain than that experience again, and the pain was considerable.

Later I had a minor surgery and they prescribed it again, but I made the doctor cut the dose in half, and then I cut the pills in half myself so I was still getting only 1/4 of the dose he thought most appropriate. It was more than enough, and I stopped taking it in two days though I had a longer course prescribed because it was still worse than the pain.

I have chronic pain. I have had morphine ("enough to put down a horse") once and dilaudid a few times, and have a script for 7.5/325 Norco. Not once in 20 years have I ever had euphoria, but I also have never had an opiate when I am not in pain, so maybe I would get the euphoria if not in pain. The withdraw symptoms suck, headache and tremors which make it difficult to sleep and can in turn lead to more pain. The side effects of long term use are also bad and have limited my lifestyle at times IBS). I have never had an issue stopping the opiates, the headaches from withdrawal (3/10) are not bad as migraines(6-9/10) or kidney stones(3-8/10, but until the DEA and police gets out of the graft business, there will be no viable, legal alternative.

I want an alternative and I have tried every class of prophylactic and abortive medicine and therapy there is aside from surgical. Most do not work for more than a year with the exception being Botox which does not prevent pain all the time.

The one period in the last 20 years when I did not have a single migraine for two years was when I used marijuana in college.

I never took a pill when I wasn't in pain either, the problem for me was that I was always in pain, 24-7. It never left. It's still there after the pills but it went from being 6-8 on the pills to being a 1-4 (on the subjective scale) off the pills.

It is the opposite for me and I have bought into the opiate scare and have gone months without taking any. The problem is my quality of life is poor during those times, my work output is terrible and I run out of vacation/sick time.

Previously, people with neuropathy had a great alternative to opioids in the anti-convulsant Pregabalin (Lyrica), but unfortunately, the Feds recently made it a controlled substance and have started cracking down on doctors prescribing it.

Pregabalin is an anticonvulsant originally developed to treat epilepsy, but then shown to also be very effective for other nerve based diseases like neuropathy. It has no physical addiction base, though some users get physiological addicted to its calming and pain deadening effects.

Making Pregabalin a controlled substance purely based upon its small potential for psychology addiction points to the utter hypocrisy of the current system.

Back in 2014 I had a series of three surgeries that left me with constant, lingering pain in one of my extremities. After each surgery, I received a prescription for about 10 days' worth of opioids. Knowing in a general sense the addictive potential, I took the meds for a day or two and then made a conscious choice to return the remaining meds to a local PD for disposal and endure any remaining discomfort on my own. Looking at this research, seems like I made a rational choice.

I should note that I didn't like the sensation I experienced while using it (out of it, nauseated) so it wasn't a hard sell to stop using it. I consider myself lucky in that regard.

Never tried opioids/hard drugs, can someone tell me what kind of effect it gives you that is so addictive? (Just curious)

You already know exactly what opiates feel like.Opiates stimulate the release of Dopamine, the "feel good" hormone. A small dose of dopamine is always running through your body and stimulates a general feeling of well being. On a vacation on a beach in the Bahamas, the body releases a little more and you feel really well. A medium dose of opiates can give you that feeling on a crazy Monday morning at the office.A dopamine spike feel like an intense euphoric pleasure, the kind your body gives as a reward for doing something *special*, like going for that first kiss or winning Olympic Gold. A high dose of opiates can induce that feeling without you ever moving your butt of the couch